NCPA sent a letter to the Centers for Medicare & Medicaid Services asking it to regulate fair and common-sense contracting guardrails between Part D plans/PBMs and pharmacies.
Among other things in the letter, NCPA requested that CMS revise its regulation to state that plans/PBMs should make their standard contracts available upon request from interested pharmacies “no later than the first week of June of each year when Part D bids are due” to give pharmacies and their contracting entities enough time (from the first week of June to Oct. 1 of each year) to analyze and negotiate a PBM contract. This will allow contracts to be finalized prior to Open Enrollment, which is from Oct. 15 through Dec. 7, and ensure that pharmacy network status is correct in Medicare Plan Finder prior to the start of Open Enrollment.
NCPA also requested CMS establish a regulation that on Oct. 1 of each year, Part D plans/PBMs must notify pharmacies or their contracting entities of the pharmacies’ network status for the upcoming plan year, with contracts signed and finalized prior to that date. NCPA asked that the regulation include that:
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Contracts must be offered anew every year, with payments and networks that cannot be changed without further negotiation and the consent of all parties.
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Plans/PBMs are not allowed to “bundle” or “tie” participation in one network to another non-Medicare Part D network.
For the full letter, click here.
